Yasuhiro Ohba

A Case of Arborecent Liver Necrosis following Continuous Arterial Infusion Chemotherapy after Resection for Liver Metastases of Alpha-Fetoprotein-producing Gastric Cancer.

症例は61歳の男性. 1998年9月30日, 肝転移を伴うAFP産生胃癌のため, 幽門側胃切除術, 肝部分切除術 (S4c+S8) を施行した. 術前の血清AFP値は5715ng/mlであった. 術後, 右肝動脈内にカテーテルを留置し, 20PODに塩酸エピルビシン20mgを動注, 引き続きフルオロウラシル (以下, 5-FU) を250mg/日, 週5日, 3週間間欠動注した. その後, 近医にて5-FUを2,500mg/週, 16回 (総量;43,750mg) 間欠持続動注を受けた. 術後9か月のCTで肝右葉のグリソンに沿った樹枝状の不染域を認めた.画像上門脈内腫瘍栓を否定できず, 肝右葉切除術を施行した. 組織学的にグリソン周囲に漏出した胆汁を伴う肝壊死であった. 本症例では5-FUの肝動脈内動注化学療法のため胆管壁内動脈の障害から胆管壊死が生じ, 胆汁漏出によるグリソン鞘炎が原因で門脈閉塞と肝壊死が生じたと考えられた. 初回手術後2年7か月の現在再発兆候なく健在である.

A CHILD CASE OF PYOGENIC LIVER ABSCESS AFTER AN OPERATION FOR APPENDICITIS

A 7-year-old boy was admitted to the hospital because of high fever and right lower abdominal pain. An abscess in the right lower quadrant was detected by ultrasonography (US) and computed tomography (CT). Appendectomy and drainage of the abscess were performed. Postoperative course was uneventful except a mild fever. However, he developed a high fever and pain in the right upper quadrant on 15th postoperative day. CT showed an abscess about 4 cm in diameter in the right lobe of the liver. Although an antibiotic therapy was started immediately. CT on the 27th postoperative day showed that the abscess was enlarged measuring 6 cm in diameter. Therefore US-guided percutaneous abscess drainage was performed under general anesthesia. About 100 ml pus was drained and B. fragilis was isolated. His clinical symptoms improved steadily and he was discharged from the hospital on the 58th postoperative day. Percutaneous abscess drainage for pyogenic liver abscess should be performed at an appropriate stage even in a child case.

A CASE OF MUCIN PRODUCING TUMOR OF THE PANCREAS IN WHICH INTRAOPERATIVE PANCREATOSCOPY WAS USEFUL

The existence diagnosis of mucin producing tumor of the pancreas is not so difficult because of its typical duodenoscopic findings and pancretographic finding. But the extent diagnosis often presents difficulty, because it mainly spreads along the mucosal layer histopathologically. This time we experienced a case of mucin producing tumor of the pancreas in which intraoperative pancreatoscopy was useful for the definite diagnosis of the mucosal spread. A 77-year-old female was seen at the hospital because of repeated epigastralgia, and was diagnosed as having a main duct type mucin producing tumor of the pancreas in the pancreatic head. Pyloruspreserved pancreatoduodenectomy was performed, and we observed the papillary tumor and irregular mucosa by intraoperative pancreatoscopy and could make the definite diagnosis of the mucosal spread. The pathological examination revealed intraductal papillary adenocarcinoma.